Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at Michigan State University on January 12, 2015. For personal use only. No other uses without permission. Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
[
musculoskeletal imaging
FIGURE 1. Photograph of the patient demonstrating a nodular mass over the tibial incision site from his previous anterior cruciate ligament reconstruction for the right knee (arrow).
]
FIGURE 3. T2-weighted magnetic resonance images (sagittal view on the left and axial view on the right) demonstrating cystic formation in the tibial tunnel from the previous anterior cruciate ligament reconstruction, with extension into the pretibial region (arrows) and the fragmentation of the bioabsorbable interference screw.
Tibial Cyst Formation Following Anterior Cruciate Ligament Reconstruction IBON LÓPEZ ZABALA, MD, Department of Orthopaedic Surgery, Hospital Clinic, Barcelona, Spain. SERGI SASTRE SOLSONA, MD, Department of Orthopaedic Surgery, Hospital Clinic, Barcelona, Spain.
T
he patient was a 31-year-old man who had undergone anterior cruciate ligament (ACL) reconstruction of the right knee 2 years prior using a hamstring autograft, with tibial fixation achieved using a bioabsorbable poly-L-lactide interference screw. The patient had returned to his preinjury activity levels, which included recreational running and soccer, without limitation at 12 months following ACL reconstruction. However, he was now being evaluated by an orthopaedic surgeon for the insidious development of a subcutaneous painful nodule over the tibial incision site (FIGURE 1), which had progressively worsened over the past month and interfered with his ability to participate in run-
ning and soccer. The patient denied any recent history of trauma or injury, and there were no constitutional symptoms or changes in his general health. Physical examination revealed no effusion or erythema, full right knee range of motion, and normal ligamentous and meniscal testing. Palpation revealed localized pain and tenderness and the presence of a firm nodular mass over the tibial incision site for the previous ACL reconstruction. Further evaluation of the region by radiography revealed widening of the tibial tunnel (FIGURE 2, available online), and magnetic resonance imaging revealed cystic formation in the tibial tunnel and the fragmentation of the bioabsorbable interference screw (FIGURE 3).
Exploration of the tibial tunnel was undertaken, and it was determined that there was no communication with the knee joint. Histological examination further revealed a fibrohistiocytic reaction, which was consistent with a response to a foreign body.1 All of the remnants of the bioabsorbable interference screw were subsequently removed and the tibial tunnel was irrigated and curetted. Diagnostic knee arthroscopy also revealed that the ACL graft was intact. The patient’s recovery was uneventful, and he successfully returned to recreational running and soccer 3 months later. t J Orthop Sports Phys Ther 2014;44(10):839. doi:10.2519/ jospt.2014.0411
Reference 1. Gonzalez-Lomas G, Cassilly RT, Remotti F, Levine WN. Is the etiology of pretibial cyst formation after absorbable interference screw use related to a foreign body reaction? Clin Orthop Relat Res. 2011;469:1082-1088. http://dx.doi.org/10.1007/s11999-010-1580-5
journal of orthopaedic & sports physical therapy | volume 44 | number 10 | october 2014 |
44-10 Imaging-Zabala.indd 1
839
9/16/2014 5:08:40 PM
[
musculoskeletal imaging
FIGURE 1. Photograph of the patient demonstrating a nodular mass over the tibial incision site from his previous anterior cruciate ligament reconstruction for the right knee (arrow).
]
FIGURE 3. T2-weighted magnetic resonance images (sagittal view on the left and axial view on the right) demonstrating cystic formation in the tibial tunnel from the previous anterior cruciate ligament reconstruction, with extension into the pretibial region (arrows) and the fragmentation of the bioabsorbable interference screw.
Tibial Cyst Formation Following Anterior Cruciate Ligament Reconstruction IBON LÓPEZ ZABALA, MD, Department of Orthopaedic Surgery, Hospital Clinic, Barcelona, Spain. SERGI SASTRE SOLSONA, MD, Department of Orthopaedic Surgery, Hospital Clinic, Barcelona, Spain.
T
he patient was a 31-year-old man who had undergone anterior cruciate ligament (ACL) reconstruction of the right knee 2 years prior using a hamstring autograft, with tibial fixation achieved using a bioabsorbable poly-L-lactide interference screw. The patient had returned to his preinjury activity levels, which included recreational running and soccer, without limitation at 12 months following ACL reconstruction. However, he was now being evaluated by an orthopaedic surgeon for the insidious development of a subcutaneous painful nodule over the tibial incision site (FIGURE 1), which had progressively worsened over the past month and interfered with his ability to participate in run-
ning and soccer. The patient denied any recent history of trauma or injury, and there were no constitutional symptoms or changes in his general health. Physical examination revealed no effusion or erythema, full right knee range of motion, and normal ligamentous and meniscal testing. Palpation revealed localized pain and tenderness and the presence of a firm nodular mass over the tibial incision site for the previous ACL reconstruction. Further evaluation of the region by radiography revealed widening of the tibial tunnel (FIGURE 2, available online), and magnetic resonance imaging revealed cystic formation in the tibial tunnel and the fragmentation of the bioabsorbable interference screw (FIGURE 3).
Exploration of the tibial tunnel was undertaken, and it was determined that there was no communication with the knee joint. Histological examination further revealed a fibrohistiocytic reaction, which was consistent with a response to a foreign body.1 All of the remnants of the bioabsorbable interference screw were subsequently removed and the tibial tunnel was irrigated and curetted. Diagnostic knee arthroscopy also revealed that the ACL graft was intact. The patient’s recovery was uneventful, and he successfully returned to recreational running and soccer 3 months later. t J Orthop Sports Phys Ther 2014;44(10):839. doi:10.2519/ jospt.2014.0411
Reference 1. Gonzalez-Lomas G, Cassilly RT, Remotti F, Levine WN. Is the etiology of pretibial cyst formation after absorbable interference screw use related to a foreign body reaction? Clin Orthop Relat Res. 2011;469:1082-1088. http://dx.doi.org/10.1007/s11999-010-1580-5
journal of orthopaedic & sports physical therapy | volume 44 | number 10 | october 2014 |
44-10 Imaging-Zabala.indd 1
839
9/16/2014 5:08:40 PM
